A Conversation with Orthopedic Surgeon Tim Greene, MD about skiing and snowboarding injuries

Tim Greene, MD is an orthopedic surgeon who is fellowship trained in sports medicine and hip arthroscopy, a cutting edge technique that has revolutionized the treatment of various hip problems. He graduated Princeton University and earned his medical degree at the Medical College of Georgia. He performed a residency in orthopedics at Emory University and served as associate team physician to the athletic teams at Georgia Tech.

Dr. Greene completed fellowship training at the Steadman Hawkins Clinic in Vail, Colorado under the direction of Dr. Marc Philippon. While there, he served as associate team physician for the U.S. Ski Team.

What are the most common ski injuries?

Orthopedic Surgeon and skier Dr. Tim Greene, has served as team physician to the US Ski Team.

Although skiing might appear to be a high risk sport, the incidence of ski injuries has actually been declining for the past 20 years. This is partially attributed to better boot and binding technology and may partially be due to the raising awareness of common ski injuries and what can be done to prevent them. The risk of sustaining a fracture is now minimal since the advent of breakaway bindings.

Today, the knee is the most vulnerable body part for a skier. The most common injury is a tear to the MCL, the Medial Collateral Ligament that supports the inside of the knee, and in second place is a tear to the ACL (Anterior Crutiate Ligament), which runs through the center of the knee and is important for stability. In skiing, the knees serve as shock absorbers. They undergo a lot of stress, absorbing the bumps and turns as you navigate the mountain. Beginning skiers may be susceptible to a torn MCL due to the mechanics of the “snowplow” technique, ironically often the first method taught. When in the snowplow position with the skis forming an arrow and the knees bent inward, there is a lot of stress put on the inside of the knee. Falling in this position can result in a sprain or strain of the MCL.

The ACL is at greater risk during skiing because the ankle is locked into position by the boot and the knee is absorbing much of the turning motion. If a skier is thrown off balance and leans back, his skis will sometimes shoot out in front of him or her creating extra torque on the knees that may rupture the ACL. The ACL can also be torn by impact to the knee or severe stress from bouncing down hard on a bump. This can also happen when turning hard and “catching an edge”. A quick jolt and rotation can also cause an injury.

Do you see the same kinds of injuries with snowboarders?

Generally the injuries are different. You don’t have the twisting motions in snowboarding that you have in skiing, so we don’t see nearly as many knee injuries as we see in skiing. Snowboarders do however tend suffer more upper extremity injuries like the shoulder or hand, which occur when they try to catch themselves during a fall.

Who is most susceptible to these injuries?

There are two sets of people who tend to get ski injuries; very beginning skiers who are not supervised on the slopes, and very experienced skiers who tend to take more risks with speed and terrain.

Why do they happen?

Many injuries, whether you are a beginner or an experienced skier, are related to weather conditions. It is important to realize that as visibility and surface conditions deteriorate, the slope or trail level goes up. If the conditions are difficult, ski down a level. In other words, In poor visibility or icy conditions, a beginner trail becomes an intermediate, an intermediate slope becomes advanced and on and on.

Another reason injuries occur is fatigue. Most people only take one or two ski vacations a year, so they try to cram the most into each day. Their bodies aren’t accustomed to exercising of 6-8 straight hours and they get tired and weak. Most injuries happen at the end of the day and that’s because the light is poor and skiers are fatigued. The combination can be very bad.

What is the best way to prevent those kinds of injuries before hitting the slopes?

Starting a conditioning and strengthening program a few months before your first trip up the mountain is a very good way to help prevent injuries. By developing good core strength your body will be in better shape to handle the stress and strength needed in skiing. Leg strengthening and balance should also be central to a conditioning program. Aerobic training will help build stamina which will help prevent fatigue which is the cause of many injuries.

Are there any other precautions to take, once on the slopes?

Ski in control. Loss of control can lead to a crash, which is the cause of the most serious accidents.

Recognize the condition of the terrain you’re on and of your own condition. Pay vigilant attention to your own level of fatigue and rest when you feel tired or weak. Weakened muscles can lead to a loss of control that can lead to a fall or a crash into another skier or stationary object like a tree or lift tower. If you are tired, take a break, if it’s icy or the snow is extra heavy, ski down a level and if you are inexperienced, take a lesson. You’ll have more fun, and the instructor will help you avoid mistakes that can lead to injury.

In addition to your own mindfulness, pay attention to weather conditions. When I was in Vail working at the Steadman Hawkins Clinic, we could tell from the weather what kinds of injuries we would see that day. If the snow was soft and powdery, you would typically see more ligament injuries from skis getting stuck in a bank. If the snow conditions were harder, you would have more fractures.

If someone is injured, what kind of treatment is involved?

Treatment depends greatly on what type of injury you sustain. Unless an injury requires emergency treatment, if you think you’ve been injured, have it evaluated by the ski patrol. Many sprains and strains can be addressed by applying the RICE principle; Rest, Ice, Compress the area, and Elevate. It is always best to follow up with an orthopedic surgeon once you get back home, who will most likely access your injury by physical exam and sometimes x-rays or an MRI. Your doctor will make a determination of the best course of treatment depending upon the severity of the injury and your general physical condition. In the case of a ligament tear, surgery may be an option but that depends on how bad the tear is, your general health and your normal level of activity.